Risk factors for biliary complications after pediatric liver transplantation: a retrospective study and twenty years of experience from a single center in China

Abstract Background: Liver transplantation (LT) has become the only possible effective treatment for children with end-stage liver diseases and some metabolic disorders. However, postoperative biliary complications (BCs) are still a challenge and threaten patients' quality of life and survival. To conduct valuable management and therapy strategies, this study retrospectively analyzed the clinical characteristics of pediatric LT patients and investigated the risk factors for BC in a single transplant center in China. Methods: Data from 174 pediatric patients (BC and non-BC) treated at the Liver Transplant Center of West China Hospital between 2001 and 2023 were collected. The authors retrospectively reviewed medical records, including patient characteristics, surgical procedures, and prognoses, and searched for risk factors of BC with univariate and multivariable analyses. Results: BCs occurred in 30 of the 174 pediatric recipients (17.2%). The main types were bile leak, biliary stricture, and cholangitis. Among them, 10 bile leaks, constituting 26.3% of all BCs, 22 biliary strictures, representing 57.9%, and 6 cases of cholangitis. Children with bile leaks or cholangitis were usually cured after conservative treatment, while children with biliary strictures needed surgical intervention or endoscopic therapies. The multivariable analyses revealed that preoperative hypoalbuminemia in recipients (OR = 22.337, 95% CI 8.054–64.969, P = 0.001), postoperative hepatic artery complications (OR = 12.308, 95% Cl 2.665–56.838, P = 0.001), and prolonged intensive care unit (ICU) stay (OR = 1.002, 95% Cl 1.000 to 1.003, P = 0.012) were independent risk factors for BC after pediatric liver transplantation. Conclusions: Preoperative hypoalbuminemia in recipients, postoperative hepatic artery complications, and prolonged ICU stay are positively associated with BC in pediatric patients after LT.